Optimizing robotic placement renal surgery: The lateral camera port technique and current results

Purpose: The successful completion of robot-assisted renal surgery requires optimal port placement in order to minimize arm collisions due to the bulky nature of the robotic system. We describe a novel technique of port placement to maximize range of motion during robotic renal surgery that has been used successfully in over 50 procedures and report on our results. Methods: Five primary ports are placed utilizing a 30 degrees lens facing upward. The camera is in the most laterally placed port between the anterior axillary line and the midclavicular line, 3 to 4 cm below the costal margin. Two 8-mm robotic ports are placed 10 to 11 cm away from the camera port, triangulated towards the kidney. Assistant ports, if desired, are located medially and placed supra- (12 mm) and infraumbilically (5 mm). Results: This technique resulted in the camera arm residing in an upward position, moving in a completely separate plane from the working robotic arms. We had no incidents of arm-camera collision in this position. We have used this port placement technique successfully in over 50 cases performed entirely robotically. We have had no need to change port location, redock the robotic system, or add additional ports during a procedure. Conclusion: We report on a port placement technique for robotic renal surgery that optimizes motion of the robotic arms, while eliminating external collisions. Placement of the camera port laterally and robotic ports anteromedially results in considerable flexibility of robotic arm movement.